Objective: To determine whether hospital level, appropriateness of care and payment method are associated with infant mortality rates (IMR) and whether HMO enrollment is associated with appropriateness of neonatal care.
Methods: We used 1995-1998 live birth and linked birth-infant death files from NYCDOH vital records. Based on maternal and infant medical conditions, the transfer variable, and level of hospital of birth and death, we estimated whether the infant received appropriate care at the hospital of birth. The logistic regression analysis only included neonatal deaths.
Results: The IMR (per 1,000 live births) was 5.9, 5.8, and 7.5 for Levels I, II, and III hospitals, respectively. In level I hospitals, the IMR was 1.5 for infants with appropriate care and 15.4 for those with inappropriate care (Rate Ratio (RR)=10.1, 95% Confidence Interval (CI)=5.5-18.3). In level II hospitals, the IMR was 2.0 for infants with appropriate care and 26.8 for those with inappropriate care (RR=13.3, CI=11.0 - 16.1). The IMR was 5.5 for infants with HMO payment and 7.3 for those with non-HMO payment. After adjusting for very low birthweight, maternal residence, maternal birthplace, and maternal ethnicity, HMO payment method was not significantly associated with inappropriate care among infants who died (odds ratio=1.2, CI=0.4 - 3.2).
Conclusion: Inappropriate care was significantly associated with infant mortality. There was no significant association between HMO payment method and appropriateness of neonatal care.
Learning Objectives: To comprehend the association between hospital level of birth, appropriateness of care, method of payment, and infant mortality rates in New York City. To understand the relationship between appropriateness of neonatal care and payment method. To be able to identify the limitations of studying regionalization of perinatal care and payment method.
Keywords: Infant Mortality, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.